Challenges of conducting a large rural prospective population-based cohort study: The keokuk county rural health study

Ann Stromquist, James Merchant, Craig Zwerling, Leon Burmeister, Wayne Sanderson, Kevin Kelly

Research output: Contribution to journalArticlepeer-review

5 Scopus citations


The Keokuk County Rural Health Study (KCRHS) is a population-based, prospective study of health status and environmental exposures of a large stratified random sample of residents in one rural Iowa county. The study focuses on injury and respiratory disease and monitors health care delivery, geriatric health, mental health, and other health outcomes, as well as behavioral risk factors for disease and injury. Injury and disease prevalence is investigated in relation to occupational, agricultural, and other environmental exposures. The KCRHS enrolled 1004 families in Round 1 (1994 to 1998) and 1002 families in Round 2 (1999 to 2004). Participants range in age from newborn to 98 years of age and are about equally divided between males and females. The families live in farm, rural nonfarm, and town households, representing men, women, and children, the elderly, farmers, and nonfarmers. The KCRHS is currently in Round 3 (2006-2011). Although the sample is stratified by residence type, the entire county is, by definition, rural, because the largest town has fewer than 2500 residents. Using the Keokuk County Rural Health Study as an example, this paper describes the methodological challenges faced in conducting a large rural prospective population-based cohort study. Some of these challenges are inherent in any large cohort study; others are unique to rural cohort studies. Topics considered include planning the study, developing the protocol, sampling, recruiting and tracking subjects, data collection and management, sustaining funding, relating to the community, and sharing data.

Original languageEnglish
Pages (from-to)142-149
Number of pages8
JournalJournal of Agromedicine
Issue number2
StatePublished - 2009

Bibliographical note

Funding Information:
This study is made possible through grants from the National Institute for Occupational Safety and Health to the Great Plains Center for Agricultural Health, Department of Occupational and Environmental Health, College of Public Health, The University of Iowa. The authors would like to thank their research staff Jill Moore, Diana Sertterh, Kathy Gleich, Sharoll Edmundson, Beth Hoylman-Henning, Craig Taylor, the late Ann Yeoman, and many others for their work recruiting and tracking subjects and collecting data, their Community Advisory Committee, and the people of Keokuk County for their steadfast support for this project.


  • Agricultural health
  • Occupational health
  • Rural cohort study
  • Rural environmental health
  • Rural health and safety
  • Rural longitudinal study
  • Rural population-based study
  • Rural prospective study

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health


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